cold ones. And though the increase of stimulus, as of heat, exercise, or distention, will produce an increased action of the stimulated fibres; in the same manner as it is produced by the increased irritability which was occasioned by a previous defect of stimulus; yet as the excesses of irritation from the stimulus of external things are more easily avoided than the deficiencies of it; the diseases of this country, except those which are the consequences of drunkenness, or of immoderate exercise, more frequently begin with torpor than with orgasm; that is, with inactivity of some parts, or of the whole of the system, and consequent coldness, than with increased activity, and consequent heat.

If the hot fit be the consequence of the cold one, it may be asked if they are proportionate to each other: it is probable that they are, where no part is destroyed by the cold fit, as in mortification or death. But we have no measure to distinguish this, except the time of their duration; whereas the extent of the torpor over a greater or less part of the system, which occasions the cold fit; or of the exertion which occasions the hot one; as well as the degree of such torpor or exertion, are perhaps more material than the time of their duration. Besides this some muscles are less liable to accumulate sensorial power during their torpor, than others, as the locomotive muscles compared with the capillary arteries; on all which accounts a long cold fit may often be followed by a short hot one.

SPECIES.

1. Febris irritativa. Irritative fever. This is the synocha of some writers, it is attended with strong pulse without inflammation; and in this circumstance differs from the febris inirritativa of Class I. 2. 1. 1. which is attended with weak pulse without inflammation. The increased frequency of the pulsation of the heart and arteries constitutes fever; during the cold fit these pulsations are always weak, as the energy of action is then decreased throughout the whole system; and therefore the general arterial strength cannot be determined by the touch, till the cold part of the paroxysm ceases. This determination is sometimes attended with difficulty; as strong and weak are only comparative degrees of the greater or less resistance of the pulsation of the artery to the compression of the finger. But the greater or less frequency of the pulsations affords a collateral evidence in those cases, where the degree of strength is not very distinguishable, which may assist our judgment concerning it. Since a moderately strong pulse, when the patient is in a recumbent posture, and not hurried in mind, seldom exceeds 120 strokes in a minute; whereas a weak one often exceeds 130 in a recumbent posture, and 150 in an erect one, in those fevers, which are termed nervous or putrid. See Sect. XII. 1. 4.

The increased frequency of the pulsation of the heart and arteries, as it is occasioned either by excess or defect of stimulus, or of sensorial power, exists both in the cold and hot fits of fever; but when the cold fit ceases, and the pulse becomes strong and full as well as quick, in consequence of the increased irritability of the heart and arteries, it constitutes the irritative fever, or synocha. It is attended with considerable heat during the paroxysm, and generally terminates in a quarter of a lunation, without any disturbance of the faculties of the mind. See Class IV. 1. 1. 8.

M. M. Venesection. Emetics. Cathartics. Cool the patient in the hot fit, and warm him in the cold one. Rest. Torpentia.

2. Ebrietas. Drunkenness. By the stimulus of wine or opium the whole arterial system, as well as every other part of the moving system, is excited into increased action. All the secretions, and with them the production of sensorial power itself in the brain, seem to be for a time increased, with an additional quantity of heat, and of pleasureable sensation. See Sect. XXI. on this subject. This explains, why at the commencement of the warm paroxysm of some fevers the patient is in greater spirits, or vivacity; because, as in drunkenness, the irritative motions are all increased, and a greater production of sensation is the consequence, which when in a certain degree, is pleasureable, as in the diurnal fever of weak people. Sect. XXXVI. 3. 1.

3. Hæmorrhagia arteriosa. Arterial hæmorrhage. Bleeding with a quick, strong, and full pulse. The hæmorrhages from the lungs, and from the nose, are the most frequent of these; but it sometimes happens, that a small artery but half divided, or the puncture of a leech, will continue to bleed pertinaciously.

M. M. Venesection. Cathartic with calomel. Divide the wounded artery. Bind sponge on the puncture. If coffee or charcoal internally? If air with less oxygen?

4. Hæmoptoe arteriosa. Spitting of arterial blood. Blood spit up from the lungs is florid, because it has just been exposed to the influence of the air in its passage through the extremities of the pulmonary artery; it is frothy, from the admixture of air with it in the bronchia. The patients frequently vomit at the same time from the disagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is rejected from the stomach.

Sometimes an hæmoptoe for several successive days returns in gouty persons without danger, and seems to supply the place of the gouty paroxysms. Is not the liver always diseased previous to the hæmoptoe, as in several other hæmorrhages? See Class I. 2. 1. 9.

M. M. Venesection, a purge, a blister, diluents, torpentia; and afterwards sorbentia, as the bark, the acid of vitriol, and opium. An emetic is said to stop a pulmonary hæmorrhage, which it may effect, as sickness decreases the circulation, as is very evident in the great sickness sometimes produced by too large a dose of digitalis purpurea.